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Biomedical subjects

M Classen

Publications and source records attributed to M Classen.

At least 217 records · Page 12Linked to original sources

[Colon endosonography. Initial experiences in clinical use].

For the first time we report about a new diagnostic technique, the endoluminal ultrasound of the colon. It enables us to examine the whole colon by an ultrasound endoscope. The ultrasound frequency of the instrument (XCF-UM2, Olympus Optical/Aloka, Japan) is 7.5 MHz, the roundview is approximately 320 degrees. The mean advantage is the combination of endoscopic inspection including biopsy and endoluminal ultrasound. First clinical experience was gained at a total of 27 examinations. It was possible to demonstrate the normal colonic wall (n = 10) in the entire large bowel, neighbouring organs could be visualized clearly and reproducibly in most cases. Pathologic findings (four carcinomas, eight polyps, five anastomoses) were correctly diagnosed by endosonography with a sensitivity of 100% and a specificity of 96%. In two cases the histopathologic work-up of the resected specimens confirmed the ultrasonographic diagnosis of malignancy, while the endoscopic biopsy indicated benign wall lesions. This suggests that endosonography may be superior to histological diagnosis by biopsy in some cases.

Adult↗

[Electromagnetic shockwave lithotripsy of gallstones. Preliminary clinical experiences].

75 applications of extracorporeal electromagnetically produced shock-waves were performed on 40 patients with symptomatic gallbladder stones (27 women and 13 men; mean age 43.5 [25-69] years). The patients had up to three stones each, with a maximal diameter of 35 mm. Computed tomography revealed partial calcification of the stones in nine patients. Stone fragmentation succeeded in all patients. Two weeks after lithotripsy two patients were free of stone. Maximal fragment diameter, as measured by ultrasound, was less than 6 mm in 19 patients, 6-10 mm in 14, and 11-15 mm in five. At reexamination of 24 patients three months later, three additional patients were free of stone by ultrasound. No significant side effects were noted during the first 30 days after the procedure. But during further observation mild pancreatitis developed in two, while in one choledochal concrements caused obstructive jaundice which necessitated endoscopic papillotomy. These results demonstrate the effectiveness of this method of fragmenting gall-bladder stones.

Adult↗

Effect of substance P on immunoglobulin and interferon-gamma secretion by cultured human duodenal mucosa.

Recently, we have demonstrated a substance P (SP)-dependent modulation of in vitro IgM and interferon-gamma (IFN-gamma) secretion by human peripheral blood mononuclear cells, as well as lymphokine activities in supernatants of cultured duodenal mucosa. Therefore we investigated other local immunoregulatory effects of SP. Duodenal biopsies of 7 healthy subjects were cultured with Pokeweed mitogen (PWM, 1 microgram/ml) for 4 days at 37 degrees C in 1 ml medium each. SP was added in concentrations ranging from 10(-12)M to 10(-6)M on day 1. Fresh media with fresh PWM were added every day. IgG, IgM, IgA (ELISA) and IFN-gamma (RIA) were determined in the culture supernatants. Values were referred to 5 mg biopsy weight and expressed as % change in basal PWM pulsed secretion, or as units/ml. 10(-6) M and 10(-12) M SP increased secretion of all immunoglobulin isotypes. Compared to controls, 10(-6) M and 10(-12) M SP led to an increase in IgM secretion of up to 73 +/- 23% and 41 +/- 32% and to an increase in IgA secretion up to 96 +/- 35% and 25 +/- 33%, respectively (alpha = 0.02 for both isotypes at 10(-6) M). 10(-12) M to 10(-6) M SP led to a significant dose-dependent increase in IFN-gamma secretion from 7.08 +/- 1.65 up to 21.8 +/- 12.6 units/ml/5 mg. The maximum effect could be seen on culture days 3 and 4. We were able to demonstrate for the first time that SP stimulates PWM pulsed immunoglobulin and IFN-gamma secretion by human duodenal immunocompetent cells. These results support the hypothesis of local neuropeptidergic-immune interactions.

Adult↗

Complications of diagnostic gastrointestinal endoscopy.

Undesired side effects and complications of gastrointestinal endoscopy and premedication are rare events. However, this is true only of endoscopic units with experienced investigators, modern equipment and monitoring. The complication rate of upper gastrointestinal endoscopy is about 0.1% with cardiopulmonary events predominating. The typical complication of colonoscopy is perforation, seen in 0.2%. The relevant ERCP specific complication is acute pancreatitis in about 1%, followed by acute cholangitis. The most serious complications of laparoscopy are hemorrhage from the liver biopsy site, bleeding from abdominal wall varices, and perforation of the colon. The cardiopulmonary mortality is low for upper gastrointestinal endoscopy as well as for colonoscopy (1 death/20,000 procedures). Premedication, chronic obstructive pulmonary disease, coronary heart disease, valvular heart disease and, last but not least, advanced age, must be considered risk factors for the development of complications of gastrointestinal endoscopy. Balanced indication, particularly in the elderly patient, should be the consequence. If possible, endoscopy should be performed without sedatives. If premedication is necessary, it should be used sparingly. Not only patients at high risk for the development of cardiopulmonary complications, but all patients undergoing endoscopy must be carefully monitored after premedication, during and after endoscopy. The non-invasive procedure of pulse-oximetry is appropriate for continuous monitoring of arterial oxygen saturation in patients with cardiopulmonary diseases, irrespective of their premedication status. Antibiotic prophylaxis is recommended in patients with valvular heart disease or prosthetic valves. Standardized cleaning and disinfection of the instruments is of great importance to avoid hepatitis B or HIV transfer.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiopancreatography, Endoscopic Retrograde↗

A new ultrasonic probe for endosonographic imaging of the upper GI-tract. Preliminary observations.

A new ultrasonic probe (7.5 MHz, diameter 3.7 mm) was used in vitro in 3 gastric resection specimens and in vivo in 12 patients in an attempt to visualize normal and pathological wall structure of the esophagus, stomach and duodenum via the working channel of a gastroscope, and of the biliary tract via the percutaneous approach. In 5 of these patients conventional endosonography was performed. The probe visualizes the normal layer structure and pathological lesions of the upper GI-tract wall, since it can be accurately positioned at the structure of interest under visual control; water is instilled into the hollow organs to improve transmission of the ultrasound beam. Intra- and transmural changes such as blood vessels in the wall of the esophagus and stomach in portal hypertension, or gastric and esophageal tumors were demonstrated. The important advantage of the probe is that it can be used in stenosed or narrowed hollow organs, where conventional endosonography fails. However, the depth of penetration of the ultrasonic beam (10-15 mm) and circumferential imaging of the gastric wall are still inferior to those of conventional endoscopic ultrasound. As the focus distance of the ultrasound probe to the biliary ducts is too small, visualization of the biliary system is incomplete. Technical improvements could make this new probe an irreplacable diagnostic tool in the future.

Diagnostic Imaging↗

A 19-year-old female with blue rubber bleb nevus syndrome. Endoscopic laser photocoagulation and surgical resection of gastrointestinal angiomata.

A case of a blue rubber bleb nevus syndrome in a 19-year-old female patient with multiple cutaneous and gastrointestinal hemangiomata is described. Recurrent GI bleeding resulted in severe chronic anemia, which was successfully treated by endoscopic laser photocoagulation and surgical resection. Both forms of therapy had to be repeated 4 years later, the patient having been well in the meantime. This combined endoscopic and surgical approach might also improve the survival of patients with severe GI hemorrhage due to blue rubber bleb nevus syndrome.

Adult↗

Effect of N-butylscopolamine on sphincter of Oddi motility in patients during routine ERCP--a manometric study.

N-butylscopolamine is a generally accepted drug for the suppression of gut motility. Although it is used during routine ERCP, only few systematic studies have been carried out in patients to investigate its action on sphincter of Oddi motility. In the present study the effect of N-butylscopolamine on the motility of the sphincter of Oddi region has been evaluated in 17 patients undergoing routine diagnostic ERCP. The pressure parameters of these patients were compared with "normal values" obtained in 23 volunteers. A dose of 40 mg of N-butylscopolamine bromide (Buscopan) i.v. significantly reduced the contraction frequency of the sphincter of Oddi from 5.4 +/- 1.2/min to 1.0 +/- 1.4/min (p less than 0.001), the contraction amplitude from 106.3 +/- 27.8 mmHg to 55.2 +/- 23.5 (p less than 0.01) mmHg, and the basal sphincter of Oddi pressure from 13.9 +/- 3.0 mmHg to 11.0 +/- 3.5 mmHg (p less than 0.05), but had no effect on the pressure gradient between the common bile duct and the duodenum. These results clearly demonstrate that N-butylscopolamine inhibits contractions of the sphincter of Oddi, and may thus facilitate the intubation of the papilla.

Adult↗

Perspectives in "electronic endoscopy". Past, present and future of fibers and CCDs in medical endoscopes.

Electronic endoscopy has undergone considerable evolution in recent years. Early instruments had poorer resolution than fiberscopes, and distorted colors significantly. The second generation of electronic endoscopes has been considerably improved, and electronic endoscopy is expected to play a major role in endoscopy in the next decade, with its enhanced teaching abilities, permanent image storage, reproduction and retrieval. An important new development has been the development of a high-resolution colonoscope & gastroscope. Electronic endoscopes are now able to produce better resolution than fiberscopes, and the future should bring further improvements in resolution with electronic instruments. A number of problems still remain to be solved with electronic endoscopy. Irregular reflection from secretions, food and blood at short focus (less than 1 cm) results in a loss of resolution, which makes electronic endoscopy particularly difficult when bleeding is brisk. Electronic endoscopes synthesize color from a strobed signal of red, blue and green in a processor. Color is dependent on brightness, and at close focus, excessive brightness in the center of the field results in erratic color reproduction. Images acquired at electronic endoscopy may be digitized for storage and processing in a computer--which, however, is not a straightforward task at the present time. Image processing in electronic endoscopy is still in its early stages, but we anticipate that new developments in early diagnosis, classification and measurement of lesions will take place. Digitized images can also be transmitted via telephone lines, and it will soon be possible to instantaneously send images across the world.

Color↗

Evaluation of inter- and intramolecular primary structure homologies of interferons by a Monte Carlo method.

Using Sellers TT algorithm, primary structure repeats have been described for interferon (IFN)-alpha, -beta 1, and gamma. To reevaluate these results and to extend them to IFN-beta 2 (interleukin-6), a modified algorithm was developed that uses a metric to define the "best" partial homology of two peptide sequences and to compare it to those detected in random permutations of the peptide. Using this approach, the known structural homologies of IFN-alpha with IFN-beta 1 and of human (Hu) IFN-gamma with murine (Mu) IFN-gamma were identified correctly. However, the primary structure repeats in the amino acid sequences of IFN-alpha, -beta 1, and -gamma turned out to be no better than those detectable in random permutations of these sequences. These results were confirmed using a different, nonlinear metric. A previously used approach to demonstrate significance was shown to produce false-positive results. No significant primary structure homologies were detected among IFN-beta 1, -beta 2, and -gamma. In contrast to the amino acid sequence analysis, the DNA sequence of HuIFN-beta 1 contained a significant repeat that had no significant counterpart in MuIFN-beta or in IFN-alpha. In conclusion, some previously reported results obtained with Sellers TT algorithm on amino acid sequences are easily explained as random similarities, and it is therefore strongly recommended that a method like ours should be used to control significance.

Algorithms↗

Frequency-dependent secretion of pancreatic amylase, lipase, trypsin, and chymotrypsin during vagal stimulation in rats.

Pancreatic enzyme secretion in rats has been shown to be stimulated differentially by the intestinal hormones secretin and cholecystokinin. Since it is unknown if activation of neural mechanisms have similar effects, it was the aim of the present study to examine in anesthetized rats the output of the pancreatic enzymes amylase, lipase, trypsin, and chymotrypsin before (15 min), during, and after (30 min each) vagal stimulation (5 ms, 10 V) with different frequencies (0.5, 5, 10, and 50 Hz). At 5 Hz, a maximal stimulation of all four enzymes was observed, with a peak towards the end of the vagal stimulation period. At 0.5 Hz, amylase, trypsin, and chymotrypsin were released not only in smaller quantities but also in a different time pattern (trypsin and chymotrypsin), with a maximum early during vagal stimulation. Lipase secretion remained unchanged at 0.5 Hz. At 10 Hz, the output of amylase, lipase, and trypsin was quantitatively less compared to 5 Hz. In contrast to stimulation at 0.5 and 5 Hz, the maximal enzyme output was reached after cessation of vagal stimulation (amylase and lipase). Chymotrypsin release did not change in response to vagal stimulation at 10 Hz. A frequency of 50 Hz had no influence on the secretion of any of the four enzymes determined. These data demonstrate that activation of the vagus nerves can lead to a differential release of pancreatic enzymes. The exact regulatory mechanisms of action are as yet unknown and remain to be determined.

Amylases↗

Soluble interleukin-2 receptor and soluble CD8 in liver cirrhosis and obstructive jaundice.

Activated lymphocytes secrete soluble interleukin-2 receptor (sIL-2R); CD8-positive lymphocytes secrete soluble CD8 (sCD8). Liver dysfunction in cirrhosis and obstructive jaundice is known to result in depressed cellular immunity. To evaluate whether this is due to real inactivation of the immune system, we measured sIL-2R and sCD8 in the serum of 46 patients with liver cirrhosis, 25 patients with obstructive jaundice, 32 patients with alcoholic liver disease without evidence of cirrhosis, 23 healthy persons and 43 patients with unrelated disease. sIL-2R in patients with cirrhosis (mean +/- s.e.m. 1499 +/- 140 U/ml) and obstructive jaundice (1517 +/- 204) was significantly increased compared with healthy subjects (363 +/- 29) and patients with unrelated diseases (685 +/- 92); sCD8 was significantly increased in patients with cirrhosis (737 +/- 63) but not in patients with obstructive jaundice (419 +/- 32) compared with healthy subjects (322 +/- 23) and patients with unrelated diseases (375 +/- 22). No difference was found between patients with cirrhosis due to alcohol abuse (n = 15) and chronic hepatitis B (n = 6). The Child-Pugh score had no significant influence on the sIL-2R or sCD8 value. In obstructive jaundice, sIL-2R correlated with alkaline phosphatase as marker of cholestasis (r = 0.43). These data show that in spite of the apparent depressed cellular immune defense both in liver cirrhosis and obstructive jaundice there is a general activation of the immune system but the CD8+ cell compartment is only activated in liver cirrhosis. The great changes of sIL-2R and sCD8 in liver dysfunction are important for the interpretation of studies using these serum proteins as markers for immune activation.

Adult↗

Galanin inhibits gastrin release from isolated rat gastric G-cells.

Enzymatically isolated rat gastric mucosal cells (0.25% G-cells) were separated by counterflow elutriation, yielding a fraction in which the G-cell content was relatively enriched to 1.4%. In this fraction, basal gastrin release (mean +/- SE) was 31.1 +/- 1.3 pg.10(6) cells-1.60 min-1 and was stimulated by 10(-8) M neuromedin C (222.3 +/- 18.1% of basal), 10(-4) M carbachol (227.5 +/- 25.9%), 10(-6) M 12-O-tetradecanoylphorbol-13-acetate (TPA) (196.3 +/- 14.7%), and 10(-3) M dibutyryl adenosine 3',5'-cyclic monophosphate (DBcAMP) (193.9 +/- 6.8%), respectively. The neuropeptide galanin was tested at 10(-10) to 10(-7) M. Galanin had no effect on basal gastrin release but reduced the responses to neuromedin C, carbachol, TPA, and DBcAMP. IC50 ranged between 1 X 10(-10) and 8.6 X 10(-10) M galanin. Although in the relatively enriched G-cell fraction D-cells were not detectable by immunocytochemistry, a low rate of somatostatin release was still measured by radio-immunoassay (5.3 +/- 0.5 pg.10(6) cells-1.60 min-1). However, galanin failed to increase this rate under basal conditions or in response to any of the stimulants tested. These results favor the assumption that galanin might exert a direct inhibitory effect on rat gastric G-cells. Galanin seems to interfere at an intracellular mechanism(s), which is induced by neuromedin C and carbachol and which is commonly activated by protein kinase C- and cAMP-mediated stimulation.

Aminopyrine↗

Effect of substance P and neurokinin A on rat parietal cell function.

In enzymatically dispersed enriched (76%) rat parietal cells we studied the effect of substance P on acid sequestration as indirectly measured by [14C]aminopyrine accumulation. Substance P (10(-8)-10(-5) M) had no effect on basal [14C]aminopyrine accumulation. Yet, the peptide reduced the response to histamine and to the postreceptor agonists forskolin and dibutyryl adenosine 3',5'-cyclic monophosphate (DBcAMP). Inhibition by substance P followed noncompetitive kinetics and reduced stimulated parietal cell function by up to 45% at 10(-5) M. The antagonist [D-Pro2, D-Trp7,9]-substance P at 10(-5) M partly reversed the inhibitory effect of substance P. Cholinergic stimulation of [14C]aminopyrine accumulation was not reduced by substance P. Neurokinin A, another tachykinin that is structurally related to substance P, was of comparable potency and efficacy in reducing [14C]aminopyrine accumulation in response to histamine, forskolin, and DBcAMP. Inhibition of forskolin- or DBcAMP-induced [14C]aminopyrine accumulation persisted in the presence of 10(-5) M ranitidine. Inhibition by substance P and neurokinin A of the response to histamine was not sensitive to pertussis toxin. Both tachykinins failed to reduce histamine- and forskolin-stimulated cAMP production. Our data suggest that substance P and neurokinin A exert a direct effect on rat parietal cells. They attenuate histamine-stimulated acid sequestration at an intracellular step that is distal to the adenylate cyclase and that does not involve pertussis toxin-sensitive GTP-binding proteins.

Aminopyrine↗

Effect of met-enkephalin and met-enkephalin-Arg6-Phe7 on bombesin-like immunoreactivity (BLI), somatostatin and gastrin secretion from the perfused rat stomach.

In the present study we examined the effect of the two endogenous opioids met-enkephalin and met-enkephalin Arg6Phe7 on gastric bombesin-like immunoreactivity, gastrin and somatostatin release. At doses of 10(-11), 10(-9), 10(-8) and 10(-6) M both peptides elicited a significant stimulation of bombesin-like immunoreactivity secretion, while the same doses of morphine were ineffective. The stimulatory effect was abolished by naloxone. Met-enkephalin and met-enkephalin Arg6Phe7 stimulated somatostatin secretion at a dose of 10(-8) M, and this effect was reversible by naloxone. Neither peptide had any effect on gastrin secretion. In conclusion, the data demonstrate that both enkephalins must be considered potential regulators of bombesin-like immunoreactivity secretion in the rat stomach.

Animals↗

Composition of amino acid infusions and effect of cholecystokinin on insulin release in dogs.

In the present study we have examined if the different composition of intravenously administered amino acid solutions is of importance for the effect of cholecystokinin (CCK) on pancreatic insulin and glucagon release in dogs. In 6 conscious dogs CCK-9 was infused intravenously at stepwise increasing doses of 5, 10 and 20 pmol/kg.h during an intravenous background infusion of Aminosteril or Aminoplasmal. Aminosteril contains more insulinogenic amino acids while Aminoplasmal contains more glucagonogenic amino acids. CCK elicited a significant stimulation of insulin levels by 10 microU/ml (p less than 0.01) in the presence of i.v. Aminosteril compared to that elicited by i.v. amino acids alone. Glucagon and glucose levels remained unchanged. During i.v. Aminoplasmal CCK-9 had no effect. Since in dogs the physiological plasma amino acid pattern following the ingestion of protein-rich meals is unknown the possibility cannot be excluded that in dogs CCK acts as a mediator of the intestinal signal which augments insulin release during ingestion of protein-rich meals.

Amino Acids↗

Stimulation of the immune response in outpatients with hepatocellular carcinomas by low doses of cyclophosphamide (LDCY), echinacea purpurea extracts (Echinacin) and thymostimulin.

Outpatients with inoperable far advanced hepato-cellular carcinomas (n = 5) were treated with LDCY--300 mg/m2 i.v. every 28 days-, echinacin--60 mg/m2 i.m.--and thymostimulin--30 mg/m2 i.m., day 3-10 after LDCY, then twice a week. Therapy was well tolerated by all patients. Their Karnofsky' index increased for 10% in the mean. A stable disease for more than 8 weeks was documented by abdominal ultrasonography in one patient. Serum levels of Alpha-Fetoprotein (AFP), Carcinoembryonic Antigen (CEA) and Tissue Polypeptide Antigen (TPA) did not increase in 2 patients. Median survival time was 2.5 months. One patient is still alive after 8 months. Absolute numbers of CD8+ cells significantly (p less than 0.02) decreased for 7% 1 day after LDCY, whereas CD4+ cells increased (p less than 0.02) from day 1-7. Numbers of natural killer (NK-) cells increased for 17% (p less than 0.05), their activity for 90% (p less than 0.05). Activities of peripheral polymorphs (p less than 0.05) increased for 27% and of Lymphokine Activated Killer (LAK-) cells for 180% (p less than 0.05).

Adjuvants, Immunologic↗